S4287 Occupational Pesticide Exposure Leading to Erosive Esophagitis and Secondary Candida Superinfection in an Immunocompetent Patient

Introduction: Pesticide exposure is a recognized occupational hazard with well-documented systemic effects. However, gastrointestinal manifestations, including esophageal injury, are rare. Even more uncommon is the development of Candida esophagitis in an immunocompetent individual following pesticide ingestion, suggesting mucosal injury as a potential predisposing factor. Case Description/Methods: A previously healthy 61-year-old woman agricultural worker presented with progressive dysphagia and odynophagia for six months, accompanied by a 15 kg unintentional weight loss and intermittent epigastric pain. Symptoms followed several incidents of ingesting food contaminated with pesticides containing alpha-cypermethrin and imidacloprid. According to the patient, there was no history of heartburn, nausea, vomiting, hematemesis, melena, alcohol consumption, or use of nonsteroidal anti-inflammatory drugs. Physical examination revealed epigastric tenderness and halitosis. Laboratory workup showed elevated CRP (18.5 mg/L), normal CBC, and negative infectious screening. Esophagogastroduodenoscopy (EGD) revealed circumferential ulcerations extending from the upper esophageal sphincter to 32 cm, along with mild gastropathy. Biopsies demonstrated erosive esophagitis with granulation tissue infiltrated by inflammatory cells and polarizable crystalloid material resembling oxalate crystals. No evidence of malignancy, HSV, CMV, or fungal infection was found. She was treated with dexlansoprazole 60 mg daily and sucralfate, with clinical improvement noted within 5–6 days. A follow-up EGD 2 months later showed ulcer healing and esophageal trachealization, at which point medications were discontinued. However, symptoms recurred 6 months later. Repeat EGD revealed esophageal strictures and white exudates. Biopsy confirmed Candida esophagitis. She was treated with fluconazole 150 mg daily for 21 days alongside 40 mg esomeprazole. Discussion: This case highlights a rare instance of pesticide-induced chemical esophagitis, evidenced by crystalline deposits and exclusion of other causes, complicated by Candida superinfection in an immunocompetent host. It underscores the potential of mucosal injury to predispose even healthy individuals to opportunistic infections. A high index of suspicion for chemical esophagitis is warranted in individuals with occupational pesticide exposure, and early endoscopic evaluation with close follow-up for secondary infections should be considered.